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PubMed2001

Going home: giving voice to memory strategies of young Mayan refugees who returned to Guatemala as a community.

Around 1982, thousands of Guatemalan Mayas fled their villages and lands to escape the Rios Montt scorched-earth policy implemented in rural areas. After more than a decade of exile, many of those refugees have returned to their homeland. This paper looks at the ways in which young Mayan refugees who have returned home after extended exile in Mexico appropriate and distance themselves from the collective project of going home. Two Mayan communities of retornados (returnees), whose paths into exile and home again differ slightly, are compared. Outside support from international organizations and cohesion in the refugee camps enabled the young people of La Victoria to see disclosure of the traumatic past from a position of strength and confrontation as the key to social change. In La Esperanza, the past is rebuilt by the youth around avoidance of recent history, and tradition appears as a bridge between past and future. The way the youth of the two communities construct their homecoming demonstrates how small changes in the migration experience may result in considerable differences in the choice of strategies, and raises important questions about assistance programs that might be developed for these populations.

Adolescent↗
PubMed2005

The association between early tracheal colonization and bronchopulmonary dysplasia.

OBJECTIVE: To evaluate the relationship between early tracheal colonization and bronchopulmonary dysplasia (BPD). STUDY DESIGN: This is a retrospective cohort study which included 308 inborn neonates admitted to the newborn intensive care unit at the University of Miami Jackson Memorial Medical Center between January 1997 and December 2000 with birthweight 500 to 1000 g, who required mechanical ventilation on the first day of life. Chorioamnionitis was diagnosed by maternal symptoms and histopathopathology. Tracheal cultures were obtained immediately after tracheal intubation. BPD was diagnosed in neonates who had supplemental oxygen requirement for more than 28 days. Pearson's chi(2) and Logistic Regression Analysis were used to evaluate the relationship between chorioamnionitis, positive initial tracheal cultures and BPD, after adjusting for confounding variables. RESULTS: In patients with chorioamnionitis, the incidence of early positive tracheal cultures was 41% compared to 16% in those without chorioamnionitis, (p < 0.00001). In patients with birthweight 700 to 1000 g, a positive early tracheal culture increased the risk of BPD (OR = 2.42, CI 1.05 to 5.62, p < 0.05). CONCLUSION: Preterm infants exposed to chorioamnionitis have an increased incidence of early tracheal colonization. This early tracheal colonization may predispose them to develop BPD.

Bronchopulmonary Dysplasia↗
PubMed2001

[Neuromuscular syndromes of the critically ill].

With the continuous improvement in the survival of critical patients, new neuromuscular syndromes are being described. The clinical finding is an acute-subacute onset of generalised weakness with difficulty in weaning the patient from the ventilator, due to polyneuropathy, myopathy, prolonged neuromuscular blockade or a combination of these disorders. Although having a multifactorial ethiopathology, the major risk factors in the development of these disorders are multiple organ failure and sepsis for polyneuropathy; corticosteroids and neuromuscular junction blocking agents (NMB) for myopathy; and NMB and renal and liver failure for prolonged neuromuscular blockade. No specific treatment exists, which is why--due to the high incidence of these syndromes and their poor prognosis, with a mortality rate higher than 50%--we should recognise, diagnose and avoid, where possible, the conditions that help the development of these disorders.

English Abstract↗
PubMed2002

[Treatment of post kidney transplantation erythrocytosis (PTE) with ACE inhibitors].

BACKGROUND: Post kidney transplantation erythrocytosis is a frequent complication in male subjects. In our experience, it occurs in approximately 20% of transplant patients receiving cyclosporine immunosuppression therapy. METHODS: Twenty-two patients with post kidney transplantation erythrocytosis were treated using ACE-inhibitors (lisinopril) at a dose of 2-5-5 mg/day for a mean period of 15 months. Owing to the onset of collateral effects, 27% of these patients requested the conversion of ACE into angiotensin II receptor antagonists (AII). Twenty out of 22 patients were male (90%). RESULTS: Treatment resulted in a 15% reduction of hematocrit values compared to basal levels, which remained stable over time. No collateral effects were recorded, either for the kidneys or in terms of hypotension. CONCLUSIONS: ACE-inhibitors (lisinopril) or alternatively the use of angiotensin II receptor antagonists, like Losartan, at low doses, is an effective and safe treatment for patients developing post-transplantation erythrocytosis (PTE).

Angiotensin Receptor Antagonists↗
PubMed2002

[Treatment of post kidney transplantation erythrocytosis (PTE) with ACE inhibitors].

BACKGROUND: Post kidney transplantation erythrocytosis is a frequent complication in male subjects. in our experience, it occurs in approximately 20% of transplant patients recciving cyclosporine inununosuppression therapy. METHODS: Twenty-two patients with post kidney transplantation erythrocytosis were treated using ACE-inhibitors (lisinopril) at a dose of 2-5-5 mg/day for a mean period of 15 months. Owing to tbe onset of collateral effects, 27% of these patients requested the conversion of ACE into angiotensin II receptor antagonists (AII). Twenty out of 22 patients were male (90%). RESULTS: Treatment resulted in a 15% reduction of hematocrit values compared to basal levels, which remained stable over time. No collateral effects were recorded, either for the kidneys or in terms of hypotension. CONCLUSIONS: ACE-inhibitors (lisinopril) or alternatively the use of angiotensin II receptor antagonists, like Iosartan at low doses, is an effective and safe treatment for patients developing post-transplantation erythrocytosis (PTE).

Angiotensin-Converting Enzyme Inhibitors↗
PubMedDate not supplied

Developing a competitive benefits program.

Offering your employees the right fringe benefits can help staff morale soar, foster loyalty, and increase the chances that a top-notch job applicant will say yes to your job offer. This article suggests practical ways to offer a competitive benefits program without breaking the bank. It includes guidance about specific benefits and suggests a dozen more extra benefits employees value and a sample cafeteria-style fringe benefits plan. Finally, the article includes guidelines about creating and using your own benefits statement with your staff; along with a model statement form you can use or adapt to your needs.

Child Day Care Centers↗
PubMed2003

The dilemma of intellectual property rights for pharmaceuticals: the tension between ensuring access of the poor to medicines and committing to international agreements.

In this paper, we provide an overview of how the outcomes of the Uruguay Round affected the application of pharmaceutical intellectual property rights globally. Second, we explain how specific pharmaceutical policy tools can help developing states mitigate the worst effects of the TRIPS Agreement. Third, we put forward solutions that could be implemented by the World Bank to help overcome the divide between creating private incentives for research and development of innovative medicines and ensuring access of the poor to medicine. Fourth, we evaluate these solutions on the basis of utilitarian considerations and urge that equitable pricing is morally preferable to the other solutions.

Developing Countries↗
PubMed2002

Development and validation of a scale measuring modern prejudice toward gay men and lesbian women.

This paper describes the psychometric properties of the Modern Homonegativity Scale (MHS), which measures contemporary negative attitudes toward gay men and lesbians (i.e., attitudes not based on traditional or moral objections to homosexuality). In Study 1 (N = 353), a preliminary version of the MHS was developed, and its psychometric properties were examined. Participants in Studies 2 and 3 (Ns = 308 and 233, respectively) completed the MHS and other attitudinal measures. The relationships among these variables were investigated to provide a more comprehensive assessment of the scale's construct validity. In Study 4 (N = 36), a behavioural expression of modern homonegativity was examined using the attributional ambiguity paradigm. The results of these studies indicate that the MHS is unidimensional, possesses a high degree of internal consistency, and is factorially distinct from a measure of old-fashioned homonegativity. As hypothesized, scores on the MHS correlated positively with political conservatism, religious behaviour, religious self-schema and modern sexism, but did not correlate significantly with social desirability bias. In addition, the MHS appears to be less susceptible to floor effects than a commonly used measure of old-fashioned homonegativity. Finally, the experimental study revealed that participants obtaining high scores on the MHS were less likely to sit beside individuals wearing T-shirts with pro-gay or pro-lesbian slogans when they could justify their seating choice on nonprejudicial grounds.

Adolescent↗
PubMedDate not supplied

A framework for considering the ethical aspects of psychiatric research protocols.

The ethics of psychiatric research has emerged as a topic of national importance. Attention to this topic has been stimulated by a number of factors, including heightened awareness of the distinct moral problems arising in the care of mental illness, the rapid development of new psychopharmaceutical agents, the emergence of evidence-based approaches in psychiatry, the expansion of clinical trials within the private mental health sector, and recent recommendations offered by the President's National Bioethics Advisory Commission (NBAC). Consequently, clinical practitioners and investigators alike will increasingly be called upon to evaluate the ethical acceptability of psychiatric research protocols encountered in their professional work. In light of this, we present a framework for considering ethical aspects of psychiatric research protocols. This framework gives emphasis to nine elements: (1) scientific issues; (2) research team issues; (3) risk and benefit in protocol design; (4) confidentiality; (5) selection, exclusion, and recruitment considerations; (6) informed consent and decisional capacity; (7) incentives; (8) institutional and peer/professional review issues; and (9) data presentation issues. Case illustrations are provided. It is hoped that enhanced knowledge of the considerations presented in this framework will ultimately improve our ability to help people with mental illness.

Clinical Trials as Topic↗
PubMed1984

Welfare for profit: moral, empirical and theoretical perspectives.

Since the 1960s there has been an increasing number of proprietary agencies engaged in the delivery of social services in the United States. This development has generally been greeted with disfavour by welfare state advocates. Various arguments have been put forward against welfare for profit on moral, empirical and theoretical grounds. This paper analyzes these arguments and proposes several basic conditions that would seem to have significant bearing on the choice between profit and nonprofit providers for a given service.

Ethics, Institutional↗
PubMed1990

Reconceptualizing nursing ethics.

This paper offers a comparative analysis of four central concepts of moral theory--autonomy, moral posture, universal vs. particular, and the role of rules and principles. These concepts are compared as they function in traditional rule-and-principle ethics and the more recently explicated ethic of care. Implications of the distinctiveness of these two extant frameworks for the development of nursing ethics are set out. In conclusion, the claim is made that an inclusive approach to these different moral visions which places them in a mutually informative relationship holds the potential to enrich and enliven the developing nursing ethic.

Choice Behavior↗
PubMed1993

The physician's virtues and legitimate self-interest in the patient-physician contract.

I will be the first to admit that we are now well into uncharted territory of the patient-physician contract. I also detect missing stretches of my dermal layer and you may spy some that I have yet to notice. In any case, I put to your serious consideration the proposal that part of the patient-physician contract must include respect for the legitimate interests of the physician by patients and third parties. The virtues of self-effacement and self-sacrifice and the concept of legitimate self-interest help us to understand in concrete, clinically applicable terms what such respect means in practice. That respect will, I think, be expressed with some variability, because there is no simple algorithm for negotiating conflicts between legitimate self-interest and the virtues of self-effacement and self-sacrifice. One important consequence of this moral variability is that the patient-physician contract and the virtues that sustain it will not yield to a single, finally authoritative account of how such conflicts should be negotiated. Instead, as we turn more attention to these matters, we will, I believe, discover that there is a range or continuum of ways in which the management of such ethical conflict can reliably be understood in the patient-physician contract. Rather than a single account of the ethical dimensions of the patient-physician contract, we should expect to develop a range of reliable accounts. A kind of rich and engaging moral pluralism should thus govern our understanding of the ethical dimensions of the patient-physician contract.(ABSTRACT TRUNCATED AT 250 WORDS)

Ethics↗
PubMed2002

A phenomenological study of wisdom in later life.

There is growing agreement that wisdom is multidimensional. But are the dimensions imputed to wisdom by recent theories congruent with major attributes of wisdom as lived by aging adults? Significant data exist on the attributes that various populations, including elderly populations, associate with wisdom. But there is little data available on what attributes and dimensions of wisdom emerge in descriptions of wisdom as lived by older adults. To produce such data, we adopted a phenomenological approach to wisdom. Interviews were conducted individually with six older adults. The interviews were audiotaped, transcribed, and analyzed using a qualitative software program known as MAX. We concluded that essential elements of wisdom as it is lived are Guidance, Knowledge, Experience, Moral Principles, Time, and Compassionate Relationships.

Aged↗
PubMedDate not supplied

Saving Tibet? An inquiry into modernity, lies, truths, and beliefs.

Social theorists have explored the ways in which quantification serves as an instrument of governance in the modern state, whether tied to concerns of population size and quality or to problems of social behavior. Biopolitics are as visible in the modern socialist states as they are in free-market democratic states, and they are perhaps nowhere more visible today than in the new global standards of "evidence-based medicine," wherein it is assumed that only quantifiable evidence can serve to establish policy, procedure, and outcome. When it comes to creating ways to "civilize" and organize their target citizenry through health development, Socialist China as relied on such technologies as much as have health development funding agencies from donor countries. In this article, I look at quantitative methods in relation to assumptions that morality can be severed from truth and that numbers are potentially morally neutral. This idea is tied not only to forms of modern subjectivity but also to the distinct ways in which certain linguistic and theoretical practices relate to provisional notions of "lying," "truth-telling," and ways of "believing." An exploration of the effects of attempts to quantify maternal behavior, morbidity, and morality in rural Tibet highlights the problem of morality within an environment in which numbers are never free-standing but, rather, are always presumed to carry moral messages, and in which domains that cannot be quantified serve as a primary basis for knowing truth. Through an exploration of rural Tibetan encounters with health development programs for safe motherhood, I provide a critique of quantification and return to questions about "belief" as a rubric that interrupts modern dichotomies of lies versus truths.

Adult↗